Обзорная статья

2019 Update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis

Michael M. WardNational Institute of Arthritis and Musculoskeletal and Skin Diseases Bethesda MarylandAtul DeodharOregon Health & Science University PortlandLianne S. GenslerUniversity of California San FranciscoMaureen DubreuilBoston University School of Medicine Boston MassachusettsDavid Tak Yan YuUniversity of California Los AngelesMuhammad Asim KhanCase Western Reserve University Cleveland OhioNigil HaroonUniversity of Toronto Krembil Research Institute Toronto Western Hospital Toronto Ontario CanadaDavid BorensteinArthritis & Rheumatism Associates Washington DCRunsheng WangColumbia University Medical Center New York New YorkAnn BiehlNational Institute of Arthritis and Musculoskeletal and Skin Diseases Bethesda MarylandMeika A. FangVA West Los Angeles Medical Center Los Angeles CaliforniaGrant H. LouieArthritis and Rheumatism Associates Wheaton MarylandVikas MajithiaUniversity of Mississippi Medical Center JacksonBernard NgUniversity of Washington SeattleRosemary BighamMichael PianinAmit ShahAmerican College of Rheumatology Atlanta GeorgiaNancy SullivanECRI Institute Plymouth Meeting PennsylvaniaMarat TurgunbaevAmerican College of Rheumatology Atlanta GeorgiaJeff OristaglioECRI Institute Plymouth Meeting PennsylvaniaAmy S. TurnerAmerican College of Rheumatology Atlanta GeorgiaWalter P. MaksymowychUniversity of Alberta Edmonton Alberta CanadaLiron CaplanRocky Mountain Regional VA Medical Center and University of Colorado Aurora

2019en

ABI

Аннотация

OBJECTIVE: To update evidence-based recommendations for the treatment of patients with ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (SpA). METHODS: We conducted updated systematic literature reviews for 20 clinical questions on pharmacologic treatment addressed in the 2015 guidelines, and for 26 new questions on pharmacologic treatment, treat-to-target strategy, and use of imaging. New questions addressed the use of secukinumab, ixekizumab, tofacitinib, tumor necrosis factor inhibitor (TNFi) biosimilars, and biologic tapering/discontinuation, among others. We used the Grading of Recommendations, Assessment, Development and Evaluation methodology to assess the quality of evidence and formulate recommendations and required at least 70% agreement among the voting panel. RESULTS: Recommendations for AS and nonradiographic axial SpA are similar. TNFi are recommended over secukinumab or ixekizumab as the first biologic to be used. Secukinumab or ixekizumab is recommended over the use of a second TNFi in patients with primary nonresponse to the first TNFi. TNFi, secukinumab, and ixekizumab are favored over tofacitinib. Co-administration of low-dose methotrexate with TNFi is not recommended, nor is a strict treat-to-target strategy or discontinuation or tapering of biologics in patients with stable disease. Sulfasalazine is recommended only for persistent peripheral arthritis when TNFi are contraindicated. For patients with unclear disease activity, spine or pelvis magnetic resonance imaging could aid assessment. Routine monitoring of radiographic changes with serial spine radiographs is not recommended. CONCLUSION: These recommendations provide updated guidance regarding use of new medications and imaging of the axial skeleton in the management of AS and nonradiographic axial SpA.

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Идентификаторы

DOI: 10.1002/acr.24025

Цитирования и источники

Цитирований: 2Использованных источников: 0

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